Exploring the Influence of Dysphagia and Tracheostomy on Pneumonia in Patients with Stroke: A Retrospective Cohort Study.

Background: Pneumonia is common in patients with tracheostomy and dysphagia. However, the influence of dysphagia and tracheostomy on pneumonia in patients with stroke remains unclear. The aim of this study was to explore the risk factors related to pneumonia, and the association between dysphagia, tracheostomy and pneumonia in patients with stroke was investigated. Methods: Patients with stroke who experienced tracheostomy and dysphagia were included and divided into two groups based on record of pneumonia at discharge. Clinical manifestations and physical examination were used to diagnose pneumonia, whereas clinical swallowing examination, and videofluoroscopy swallowing studies (VFSS) were used to evaluate swallowing function. Results: There were significant differences between the pneumonia group and the no pneumonia group in total tracheostomy time (6.3 ± 5.9 vs. 4.3 ± 1.7 months, p = 0.003), number of instances of ventilator support (0.41 ± 0.49 vs. 0.18 ± 0.38, p = 0.007), PAS score (5.2 ± 1.92 vs. 4.3 ± 1.79, p = 0.039), impaired or absent cough reflex (76.4 vs. 55.6%, p = 0.035), oropharyngeal phase dysfunction (60.6 vs. 40.8%, p = 0.047), length of hospital stay (36.0 ± 7.2 vs. 30.5 ± 11.7 days, p = 0.025) and direct medical costs (15,702.21 ± 14,244.61 vs. 10,923.99 ± 7250.14 United States dollar [USD], p = 0.042). Multivariate logistic regression showed that the total tracheostomy time (95% confidence interval [CI], 1.966−12.922, p = 0.001), impaired or absent cough reflex (95% CI, 0.084−0.695, p = 0.008), and oropharyngeal phase dysfunction (95% CI, 1.087−8.148, p = 0.034) were risk factors for pneumonia. Spearman's correlation analysis demonstrated that PAS scores were significantly correlated with cough reflex dysfunction (r = 0.277, p = 0.03), oropharyngeal phase dysfunction (r = 0.318, p < 0.01) and total tracheostomy time (r = 0.178, p = 0.045). The oropharyngeal phase dysfunction was significantly correlated with cough reflex (r = 0.549, p < 0.001) and UES opening (r = 0.643, p < 0.01). Conclusions: Tracheostomy and dysphagia increased the risk of pneumonia in patients with stroke. Total tracheostomy time, duration of ventilator support, degree of penetration and aspiration, and oropharyngeal phase dysfunction are risk factors. Given this, we also found that there may be a correlation between tracheostomy and dysphagia.

Characteristics of dysphagia among different lesion sites of stroke: A retrospective study.

Objective: This study aims to compare the characteristics of dysphagia among different lesion sites and explore the possible risk factors that are relevant to penetration and aspiration after stroke. Materials and methods: Data on patients with post-stroke dysphagia were collected. Major measures of the videofluoroscopic swallowing study included pharyngeal transit duration (PTD), pharyngeal response duration (PRD), soft palate elevation duration (SED), stage transition duration (STD), hyoid bone anterior-horizontal displacement (HAD), hyoid bone superior-horizontal displacement (HSD), upper esophageal sphincter opening (UESO), Pharyngeal Residual Grade (PRG), and Penetration Aspiration Scale (PAS). Included patients were divided into supratentorial (deep or lobar intracerebral) and infratentorial stroke groups. The Kruskal-Wallis test, Spearman's correlation analysis, and multivariate logistic regression analyses were used to test the difference and the correlation between those measures. Time-to-event endpoints (oral feeding) were analyzed by the Kaplan-Meier method. Results: A total of 75 patients were included in this study. Significant differences were demonstrated in PTD, PRD, SED, STD, HAD, HSD, UESO, PAS, and PRG between supratentorial and infratentorial stroke groups (p < 0.05). The PRG score of the lobar intracerebral subgroup was significantly higher (p < 0.05) than that of the deep intracerebral and lobar + deep intracerebral stroke subgroups, while HSD was significantly shorter (p < 0.01). Spearman's correlation analysis revealed that PAS was related to PTD, PRG, HAD, and UESO (p < 0.05). Multivariate logistic regression analysis demonstrated that HAD and PRG may be risk factors for penetration and aspiration (p < 0.05). Kaplan-Meier survival plot showed that there was a significant difference in time to oral feeding between supratentorial and infratentorial stroke groups (p < 0.01). Conclusion: Infratentorial stroke may lead to worse swallowing function as compared with supratentorial stroke, and lobar intracerebral stroke may be worse than deep intracerebral stroke. Suitable preventive measures may be considered for patients with higher PRG scores and shorter HSD to avoid penetration and aspiration.

Relationship between Post-Stroke Cognitive Impairment and Severe Dysphagia: A Retrospective Cohort Study.

Objective: To investigate the relationship between post-stroke cognitive impairment (PSCI) and severe post-stroke dysphagia (PSD) and explore the risk factors related to PSCI combined with severe PSD. Methods: Data from patients were collated from the rehabilitation-specific disease database. The Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Videofluoroscopy Swallowing Study (VFSS), Penetration-aspiration Scale (PAS), and Functional Oral Intake Scale (FOIS) were used to evaluate cognitive and swallowing functions. Differences between groups were determined by the Pearson chi-square test (χ2) or Fisher exact test. PAS and FOIS data were analyzed with the use of the Wilcoxon rank-sum or Kruskal−Wallis test in the prespecified subgroup analysis. Risk factors were investigated by multivariate logistic regression. Results: A total of 1555 patients were identified with PSCI. The results indicated that patients with PSCI had a higher incidence rate of severe PSD as compared to patients without PSCI (p < 0.001). Patients with severe PSCI were more likely to clinically manifest oral phase dysfunction (p = 0.024), while mild PSCI patients mainly manifested pharyngeal phase dysfunction (p < 0.001). There was a significant difference in FOIS score changes between subgroups during the hospitalization period (severe PSCI vs. moderate PSCI and severe PSCI vs. mild PSCI) (all p < 0.001). In addition, multivariate logistic regression revealed pneumonia (p < 0.001), tracheotomy (p < 0.001), and dysarthria (p = 0.006) were related to PSCI, combined with severe PSD. Conclusion: PSCI may be related to severe PSD. Patients with severe PSCI were more likely to manifest oral phase dysfunction, while mild PSCI manifested pharyngeal phase dysfunction. Pneumonia, tracheotomy, and dysarthria were risk factors related to PSCI combined with severe PSD.

The Effect and Optimal Parameters of Repetitive Transcranial Magnetic Stimulation on Poststroke Dysphagia: A Meta-Analysis of Randomized Controlled Trials.

Objective: The objectives of the study were to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) treatment for poststroke dysphagia (PSD) and explore the optimal stimulation parameters. Method: The databases of Medline, Embase, Web of Science, and Cochrane Library were searched from the establishment to June 2021. All randomized controlled trials about rTMS treatment for PSD were enrolled. Dysphagia Grade (DG) and Penetration Aspiration Scale (PAS) were applied as the major dysphagia severity rating scales to evaluate the outcomes. Results: A total of 12 clinical randomized controlled studies were included in our study. The summary effect size indicated that rTMS had a positive effect on PSD (SMD = -0.67, p < 0.001). The subgroup analysis for treatment duration and different stroke stages showed significant differences (treatment duration >5 days: SMD = -0.80, p < 0.001; subacute phase after stroke: SMD = -0.60, p < 0.001). Furthermore, no significant differences were observed among the other stimulation parameter subgroups (including stimulation frequency, location, and a single stimulation time) (p > 0.05). Conclusion: rTMS is beneficial to the recovery of PSD patients, while an intervention of more than 5 days and in the subacute phase after stroke might bring new strategies and rational therapeutics to the treatment of PSD. Systematic Review Registration: http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022299469.

Role of 5-HT1A in the nucleus of the solitary tract in the regulation of swallowing activities evoked by electroacupuncture in anesthetized rats.

Somatic stimulation therapy, such as electroacupuncture (EA), has been widely applied in the clinic to treat dysphagia. However, its underlying mechanism has remained unknown. In the present study, the effect of EA at acupoints Fengfu (DU16) and Lianquan (RN23) on swallowing activities and the involvement of 5-HT1A in the nucleus of the solitary tract (NTS) were examined in anesthetized rats. EA at DU16 and RN23 significantly evoked myoelectric activity of the mylohyoid muscle, which was attenuated by injection of 10 nmol 5-HT1A antagonist (WAY-100635) into the NTS. Meanwhile, 5-HT1A expression in the NTS increased following EA. The results suggested that EA at DU16 and RN23 promotes swallowing activity, and 5-HT1A in the NTS may play an important role in the excitatory effects.

Construction of a fusion expression plasmid containing the G250 gene and human granulocyte-macrophage colony stimulating factor and its significance in renal cell carcinoma.

This study aimed to construct a eukaryotic expression plasmid containing the G250/MN/CA IX (G250) and human granulocyte-macrophage colony stimulating factor (hGM-CSF) genes, and to detect the expression of these proteins in vitro by recombinant plasmids in eukaryotic cells. pORF-hGM-CSF and pcDNA3.0-G250 were used as the template to amplify G250 and hGM-CSF by routine polymerase chain reaction (PCR). The two PCR products were cloned into the eukaryotic vector pVAX1, in order to construct a recombinant plasmid pVAX1-G250-hGM, and the plasmid was transfected into human embryonic kidney 293 cells. The protein expression was then determined by immunocytochemistry, atomic force microscopy, ELISA and Western blotting. DNA sequencing showed that the cloned G250 and hGM-CSF sequences were consistent with the reported Gene Bank ones. Moreover, a high expression was noted following recombinant plasmid transfection of the G250 and hGM-CSF proteins. Thus, the eukaryotic expression vector pVAX1-G250-hGM containing G250 and hGM-CSF was constructed, allowing for the investigation of the anti-G250 antigen vaccine and immune response mechanisms of biological immunotherapy in renal cell carcinoma.

Cloning of a fusion gene containing hGM-CSF gene and gene encoding L protein of HBV and expression in Pichia Pastoris.

BACKGROUND/AIMS: To construct the yeast expression vector containing cDNA sequence coding L protein of Hepatitis B Virus (HBV) and human granulocyte-macrophage colony stimulating factor (hGM-CSF), and to explore the method of secretory expression in Pichia Pastoris GS115 strain. METHODS: We used pVAX1-L-hGM as template to amplify L-hGM gene by PCR, and then the PCR products were cloned into the yeast expression vector pPICZaC with DNA recombination method. After linearized by Sac I, the recombinant plasmid pPICZa C-L-hGM was transformed into Pichia Pastoris GS115 by electrophoresis. The expressing protein was induced by methanol. SDS-PAGE and Western blot were used to analyze the expression of protein. RESULTS: DNA sequence analysis revealed that the constructed genes sequences were totally consistent with the GeneBank reported. The results of SDS-PAGE and Western blot showed that the recombinant protein was induced by methanol and stably expressed in Pichia Pastoris. CONCLUSIONS: The successful construction of a recombinant yeast expression vector containing gene coding L protein of Hepatitis B virus and hGM-CSF gene, and expressed in Pichia Pastoris, of which lays a foundation for the further researches on a better protective HB vaccine.